PMID- 20210713
OWN - NLM
STAT- MEDLINE
DCOM- 20100607
LR  - 20191111
IS  - 2212-3911 (Electronic)
IS  - 1574-8863 (Linking)
VI  - 5
IP  - 1
DP  - 2010 Jan
TI  - Optimizing sustained use of sedation in mechanically ventilated patients: focus 
      on safety.
PG  - 6-12
AB  - Optimizing sustained use of ICU sedation in mechanically ventilated patients 
      requires careful consideration of drug-specific characteristics (E.G. 
      pharmacokinetics), consideration of potential adverse effects in susceptible 
      patients, and utilization of sedation-minimizing strategies. In the era of 
      anxiolytic dosing protocols adjusted to specific patient behaviors as defined by 
      sedation scales in conjunction with daily interruption, midazolam is a reasonable 
      option for long-term sedation. Propofol is an appealing agent for ICU sedation 
      due to it's pharmacokinetic profile and a reduced propensity to result in 
      prolonged sedation. However, care should be taken to monitor for potential 
      devastating adverse effects including hypertriglyceridemia and propofol-related 
      infusion syndrome (PRIS). Dexmedetomidine unreliably provides adequate sedation 
      at doses currently approved by the FDA, though upward titration of 
      dexmedetomidine coupled with rescue benzodiazepines and/or fentanyl appears to be 
      safe and comparable to benzodiazepines in the achievement of light to moderate 
      Richmond Agitation Sedation Scale (RASS) goals. Clinicians should closely monitor 
      patients receiving dexmedetomidine for hemodynamic-altering bradycardia. 
      Strategies that promote frequent patient assessment with corresponding sedative 
      dose minimization have demonstrated the benefits of limiting oversedation. 
      Implementation of a sedation protocol requires careful consideration of ICU 
      resources and staffing such that efforts made are sustainable and will be safe 
      and effective for the patient population affected.
FAU - Arnold, Heather M
AU  - Arnold HM
AD  - Department of Pharmacy, Barnes-Jewish Hospital, St. Louis, MO 63110, USA.
FAU - Hollands, James M
AU  - Hollands JM
FAU - Skrupky, Lee P
AU  - Skrupky LP
FAU - Mice, Scott T
AU  - Mice ST
LA  - eng
PT  - Journal Article
PT  - Review
PL  - United Arab Emirates
TA  - Curr Drug Saf
JT  - Current drug safety
JID - 101270895
RN  - 0 (Hypnotics and Sedatives)
RN  - 67VB76HONO (Dexmedetomidine)
RN  - YI7VU623SF (Propofol)
SB  - IM
MH  - Bradycardia/chemically induced
MH  - Critical Care/*methods
MH  - Dexmedetomidine/administration & dosage/adverse effects
MH  - Dose-Response Relationship, Drug
MH  - Drug Monitoring/methods
MH  - Humans
MH  - Hypertriglyceridemia/chemically induced
MH  - Hypnotics and Sedatives/*administration & dosage/adverse effects/pharmacokinetics
MH  - Propofol/administration & dosage/adverse effects/pharmacokinetics
MH  - Respiration, Artificial/*methods
RF  - 52
EDAT- 2010/03/10 06:00
MHDA- 2010/06/09 06:00
CRDT- 2010/03/10 06:00
PHST- 2009/03/28 00:00 [received]
PHST- 2009/04/29 00:00 [accepted]
PHST- 2010/03/10 06:00 [entrez]
PHST- 2010/03/10 06:00 [pubmed]
PHST- 2010/06/09 06:00 [medline]
AID - CDS ABS-28 [pii]
AID - 10.2174/157488610789869102 [doi]
PST - ppublish
SO  - Curr Drug Saf. 2010 Jan;5(1):6-12. doi: 10.2174/157488610789869102.